Allison Janney fulfilled a lot of “The West Wing” fan fantasies today when she went to the White House and briefed the press corps as C.J. Cregg. For those of you who haven’t watched “The West Wing,” Cregg was Janney’s Emmy-winning portrayal of the White House Press Secretary. Also those of you who haven’t watched “The West Wing” should do so immediately, but that’s a whole different point. But Janney’s appearance in the White House briefing room wasn’t just intended to cause nostalgic revelry for fans of the Aaron Sorkin classic. While borrowing current White House Press Secretary John Earnest’s podium, Janney talked about combatting the incredibly serious opioid epidemic in the United States.

While Janney’s reason for visiting was serious and apt, it didn’t stop her from making some delightful references to the show. She began by telling the assembled press that she was filling in for Earnest because he had a root canal–a favorite funny moment from the show. She also promised that she would perform the “Jackal,” another one of C.J. Cregg’s trademark scenes.

But after just a few good-hearted jokes, Janney told the press why she was really there. She discussed the show she now stars on, called “Mom,” which features recovery from substance abuse as a consistent theme. Janney also has a personal history with substance abuse recovery–her brother committed suicide after a long struggle with addiction. While at the podium, Janney explained that the White House is honoring 10 individuals as “Champions of Change” for their work to fight substance abuse and to help those who are now in recovery. Janney stated:

This is a disease that can touch anybody, and all of us can help reduce drug abuse through evidence-based treatment, prevention and recovery. Research shows it works, and courageous Americans show it works every day.

On her way out, one of the reporters asked Janney who President Jed Bartlett (played by Martin Sheen) would hypothetically support in the Democratic primary. Janney replied with all the grace and poise of her press secretary character, retorting: “I think you know the answer to that question.” That quip could be a reference to the fact that her fellow “The West Wing” star, Bradley Whitford, has said that the fictional president would vote for Hillary Clinton. Whitford stated: “There’s no doubt in my mind that Hillary would be President Bartlet’s choice. Nobody is more prepared to take that position on day one.”

Cregg’s appearance, while certainly unexpected, was very welcome and entertaining–and supported a great cause. As the 2016 primaries drag on and just get more depressing, sometimes it’s fun to be reminded of one of the best fictional presidents of all time.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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In most cases, the law grants people autonomy over their own bodies, including a constitutional right to consent to or refuse medical treatment; however, for teenagers, that right is curbed by their parents, who have the right to control medical procedures in most cases until that child turns eighteen. There has been a lot of news lately where teens are fighting back against their parents over medical treatments, procedures, and even appointments. Read on to learn more about this issue, including mental health, substance abuse, and physical problems.

Parent – Child Medical Care

Traditionally when a teenager, child, or infant goes for medical treatment, including routine check-ups, parents are welcome in the room. Many doctors’ offices allow the parent in, while some do so only if the child says the parent can come in. This is especially true in more sensitive appointments. In most cases, a child’s parents or guardians are the ones who know the most about the child.

According to the University of Washington School of Medicine:

Parents have the responsibility and authority to make medical decisions on behalf of their children. This includes the right to refuse or discontinue treatments, even those that may be life-sustaining. However, parental decision-making should be guided by the best interests of the child. Decisions that are clearly not in a child’s best interest can and should be challenged.

The concern that a parent could make a decision that isn’t in their child’s best interest has led to some cases where children and teenagers start to fight back against their parents when it comes to medical care.

What are age of consent laws?

Doctors of all kinds, from dentists to ophthalmologists, have grappled for years with age of consent when it comes to mature adolescents. In a 2013 Pediatrics article, the authors stated:

It is well understood in the medical community that adolescents’ aptitude to make rational, responsible decisions changes over time and that older teenagers and young adults have substantially similar cognitive capacities.

According to Doctor Will See You Now, this question of maturity, and the automatic assumption of parent’s rights, endures as the general background rule that will apply in the majority of court cases regarding treatment of teens. The site points out that most frequently, parents are “free to sort among alternatives and elect the course of treatment based on his or her assessment of the child’s best interests.” This rule applies to any patient below the age of majority, 18 in most states, although in a small number of states, such as Delaware (19), Mississippi (21), and Nebraska (19),  it is higher. In Arkansas, Nevada, Ohio, Utah, and Wisconsin the age of majority varies due to high school graduation dates. Some health insurance plans also have rules associated with their policies.

Those who are evaluated to have a maturity over their physical age, however, have been deemed “mature minors” in some court cases. That concept, as psychologically valid as it is, is cloudier when it comes to state laws, which vary widely in their “mature minor” stances, including the ages at which one becomes a “mature minor.” SeverFew U.S. courts have already defined the term, and a few more will be tasked to evaluate it in coming months. Seventeen states do have some form of concession to the standard parental consent requirement, ranging from written exceptions from psychologists to emancipation rights. Most often, the exceptions are requested by minors seeking an abortion without parental consent or knowledge.

These rules have become increasingly open to exceptions aiming to protect minors’ privacy and bodily integrity, safeguard the public health, and respect older minors’ adult-like autonomy and decision making ability.

Sensitive Categories of Treatment: Exceptions to the Rule

All states have some exceptions to parental consent when it comes to medical care for minors. It can become public health issue if young people are scared to get medical treatment because they have to tell their parents about them. These include procedures like testing for STDs–something that all 50 states and D.C. allow minors to do without having parental permission.

In many states, but not all, minors can also give their personal consent without their parents’ input regarding reproductive health services, with regard to contraceptive services and prenatal care, as well as drug and alcohol abuse treatment and outpatient mental health services. However, there usually is a minimum age for this kind of care without parental consent–usually early teens. These laws also don’t preclude parents from being able to require them to submit to treatment.

Abortion

One specific area of concern when it comes to minor medical care is abortion. Most states require parental consent for a minor to receive an abortion, although Supreme Court precedent allows a pregnant minor to receive an abortion under certain circumstances, such as “if she is sufficiently mature or if it would be in her best interests mentally and physically.” “Tests of maturity can include questions about good grades or extracurricular activities, as well as other less-defined queries that would allow judges to see a young person’s thinking process and understanding of the procedure,” said Doriane Coleman, a law professor at Duke University. The law is pretty inconsistent state-by-state, however, in some states, another relative could be allowed to be present at the abortion, in others a young woman could go to court to fight for her right to have the medical procedure.

Substance Abuse

When it comes to substance abuse, some states allow minors to consent to treatment. However, the laws usually also require that minors have to receive treatment if their parents consent to it on their behalf. Allowing minors the option to consent is is an attempt to make sure the treatment sticks–after all, a person who consents to treatment or requests treatment is more likely to follow through and at least stay in the program until the end.

According to the Doctor Will See You Now:

For doctors, the issue is that even if a minor is empowered by state law to give consent, they still need to ensure that the minor is intellectually and emotionally capable of giving informed consent. Thus, even if there is no age limit under state law or the age limit is very low, at times doctors may find it is inappropriate to allow a minor to consent to his own care if he is too immature or otherwise incapable of understanding the procedure’s risks, benefits and alternatives.

Payment, Confidentiality, and HIPAA

Additionally, the Doctor Will See you Now points out:

The fact that some minors can consent to their own health care and treatments in certain areas does not always mean that they actually have a right to confidentiality with respect to that care. Under the Health Insurance Portability and Accountability Act (HIPAA), practitioners are basically required to follow state law regarding confidentiality for minors, and they are given discretion over parental notification when state law is silent on the issue. Most parents will find out eventually, whether it is from HIPAA or the patient’s own volition.

Particular federally funded programs also have certain confidentiality laws. For example, services subsidized by Title X, the federal family planning funding program, have to be provided confidentially, per federal law.

Case Study: Cassandra C.

The Connecticut Supreme Court ruled recently that the state was well within its rights to require a young woman named Cassandra C. to continue undergoing chemotherapy treatments even though it wasn’t what she wanted. Her mother wanted her to do whatever she thought was best.

Because of the nature of the case, and concerns about Cassandra’s wellbeing, the case has been featured in the national news. Unfortunately, Cassandra spent every day in isolation from other patients and was under constant supervision. “She hasn’t been convicted of a crime, but it’s kind of like she’s in jail,” said Joshua Michtom, an assistant public defender and Cassandra’s lawyer. “It’s an especially lousy way to go through chemo.”

Court Orders

There are very rare situations in which the court becomes involved, because parents aren’t acting in the best interests of their children. In addition, there are cases like those outlined in the novel My Sister’s Keeper, where parents seek to have a minor child donate an organ to a sibling, or to undergo any other significantly invasive medical procedure for the benefit of another child.

Conclusion

Medical decision making by and on behalf of children and teens is a subject that is ethically, mentally, physically, and legally complex. State laws vary considerably, and they often have vague standards and language. Children should generally be involved in medical decision making to the extent of their abilities. It is not only a teaching moment, but it is also a way to create autonomy. In the case of a conflict between a minor’s wishes and a parent’s wishes, however, everyone needs to proceed with caution, especially in life or death cases. As such, it is usually wise for them to seek the advice of legal counsel and, in some cases, to proceed to court for a judicial order authorizing the proposed course of treatment.

Resources

Primary

District Court of Appeal of Florida, First District: DEPT. OF HEALTH v. STRAIGHT, INC.

Eastern District Court of Pennsylvania: Parents United for Better Schools v School District of Philadelphia

Additional

The Doctor Will See You Now: Doctor-Patient Confidentiality: How Do We Define It and When Should We Waive It?

Journal of Health Care Law and Policies: Medical Decision Making by and on Behalf of Adolescents

Journal of Pediatric Psychology: Involving Children and Adolescents in Medical Decision Making: Developmental and Clinical Considerations

Guttmacher Institute: Minors and the Right to Consent to Health Care

Philly: Should Teens Get to Say “No” to Life-Saving Medical Treatment?

Pediatrics: The Legal Authority of Mature Minors to Consent to General Medical Treatment

Editor’s Note: This article has been edited to credit select information to the Doctor Will See you Now, and some portions have been edited for clarity. 

Noel Diem

Law Street contributor Noel Diem is an editor and aspiring author based in Reading, Pennsylvania. She is an alum of Albright College where she studied English and Secondary Education. In her spare time she enjoys traveling, theater, fashion, and literature. Contact Noel at staff@LawStreetMedia.com.

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Stories about marijuana and alcohol abuse on university campuses seem to consume the media, but what about prescription drug abuse? Students who abuse prescription pills tend to be overlooked because many of them do not fit the “criminal” profile; yet Adderall and other medications can be incredibly dangerous and very addictive.

Although many cases easily slide under the radar, in April of 2014, University of Colorado officials decided to crack down when two students were arrested for selling Adderall at their school. Christopher Valentine and Graham Hankin will be facing felony criminal charges for selling their prescriptions, at $4-$5 per pill.

According to CNN, “researchers estimate about 30 [percent] of students use stimulants non-medically.” This is becoming an epidemic in universities, and has even trickled down into middle school and high school communities.

These teens and young adults are not drug addicts; they are students with motivation and goals. As a matter of fact, many of them go to Ivy League schools and have professional plans. But good intentions can quickly turn bad when an innocent pop of a pill becomes a dangerous addiction. The scary thing about prescription drugs is that one might assume that they are safe because they are regulated by the FDA. However, assuming that prescription drugs are harmless is very dangerous–Adderall is an amphetamine, comparable to cocaine or speed, and when taken in non-regulated doses it can be lethal.

How Does Adderall Work?

Adderall creates a constant flow of dopamine. It continuously sends a supply of the feel-good neurotransmitter to the prefrontal cortex of the brain, which regulates behavior, emotional processing, and cognition. According to Synapse, Penn’s Undergraduate Medical Connection research center, “stimulating this region of the brain predictably causes increased alertness, wakefulness, and concentration.”  These chemical reactions cause the high that students report feeling.

What are the Side Effects Associated with Unregulated Use?

The side effects of excessive usage are not pretty. Because of the “speed” like qualities and caffeine in Adderall, it has been linked to “cardiovascular complications.” In extreme cases Aderall abuse can lead to a stroke. More common side effects include heart palpitations and a rapid heart beat. Physically, Adderall can cause teeth grinding, and since it’s an appetite suppressant, it can cause extreme weight loss.

Psychological disturbances such as depression, paranoia, and anger have also been reported. When a regular user decides to quit the drug, they will experience symptoms similar to those felt by recovering narcotics addicts. According to a source from Study Drugs, “I slept an hour a night for a week straight [while on Adderall.]” Once she stopped taking the drug, she slept and ate non-stop for several days in a row to compensate for her loss of sleep. At the rate at which her brain was processing information, the source claims that, “she wasn’t living in the moment.”

To hear three personal perspectives from students check out this clip:

How do so Many Students get Their Hands on Adderall?

Many students are prescribed Adderall for ADHD; yet those students can sometimes function without their medication, so they sell their prescriptions for an elevated price. The dealer makes a profit, and the student buyer has a steady dose of Adderall to get them through exams and papers.

Here’s a shorts news clip and interview on the fad:

Just as any fad catches on, someone who tries Adderall talks about the success that they have with the drug and their grades. The word spreads, and other students begin to seek out someone who has a  prescription. Students that have never even touched alcohol or narcotics want the drug for its practical purposes. They have very little knowledge of what they are taking; or even if they do, they feel that the positive effects of the drug outweigh the negative health and psychological effects. Sometimes it’s too late, and similarly to any addiction, the users’ decision-making becomes overpowered by their desire to have the drug.

Who is to Blame for this Epidemic?

According to the Partnership for Drug-Free Kids:

Recent media reports underscore the massive surge in the prescribing of prescription stimulants to our nation’s children. Combine the existing daily damage from prescription opioid abuse together with a range of other medicines that are abused, and we ourselves have created this crisis.

In 2009, youth abused marijuana the most, but prescription drugs ranked second. Acquiring prescription pills is not difficult for the average student. Students can easily go to a psychologist and claim that they are experiencing ADHD-like symptoms and receive a prescription. Whether the student abuses their own prescription or buys from a friend, prescription stimulants are not regulated or penalized nearly as often as they should be.

How do we stop it?

On June 11, there was a conference held at Temple University in Philadelphia to promote the safety and regulation of prescribed pills at universities.  Michael Botticelli, the  director of National Drug Control Policy, led the conference and spoke about methods to manage the abuse of prescription pills. A few of his tactics included pharmaceutical regulation and personal assessment of the distributor and the situation. He also suggested the importance of “disposal programs,” which emphasize throwing away prescriptions after the patient is finished with the bottle.

A less passive way to regulate the illegal sale of Adderall would be to crack down on the overall drug trafficking on campuses. Search and seizure policies have led to students being kicked out of universities for many years. If campuses crack down, there will be a large number of students who will face either educational consequences, or in more extreme cases, criminal convictions. Legal action will cause students to take the issue more seriously; they are more likely to stay away from these illegal behaviors if there is a clear consequence.

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Madeleine Stern (@M3estern) is a student at George Mason University majoring in Journalism and minoring in Theater. Her writing on solitary confinement inspired her to pursue a graduate degree in clinical counseling after graduation. Madeleine is an avid runner, dedicated animal lover, and a children’s ballet instructor. Contact Madeleine at staff@LawStreetMedia.com.

Featured image courtesy of [Simone via Flickr]

Madeleine Stern

Madeleine Stern attended George Mason University majoring in Journalism and minoring in Theater. Her writing on solitary confinement inspired her to pursue a graduate degree in clinical counseling after graduation. Madeleine is an avid runner, dedicated animal lover, and a children’s ballet instructor. Contact Madeleine at staff@LawStreetMedia.com.

The post The Adderall Epidemic: Speed for Success appeared first on Law Street.

The state of Wisconsin has a law that has been dubbed the “cocaine mom” law. The idea, in theory, is supposed to protect fetuses from mothers who have drug or alcohol problems and may harm their unborn children. The law contains specific language that the provisions in this law are only supposed to be used in a situation in which a mother may harm her child to a severe degree. In addition to Wisconsin, Minnesota, Oklahoma, and South Dakota have these laws in place, while 20 other states have tried and failed to pass them.

A New York Times article by Erik Eckholm published earlier this week explored the horrifying implications of this law. The editorial focused on the story of a twenty-eight year old woman named Alicia Beltran. Fourteen weeks into her pregnancy she went in for a prenatal checkup. She was honest with her doctor about an addiction to Percoset, a prescription painkiller. She had kicked that addiction a few months before. She had also briefly taken a medication called Suboxone, which is intended to help addicts kick their addictions. It is safe even for pregnant women. She borrowed it from a friend, and did not have a prescription for it, because she could not afford one. But she waned herself off of it a few days before she even went in for pre-natal care.

After explaining her situation to her doctor, she took a urine test that showed only traces of Suboxone, which she had disclosed to her doctor. Later tests showed no drugs in her system. The physician’s assistant she had seen for her check-up report told her that if she wanted to continue to take Suboxine, that she should get a prescription. That decision was backed up by the OBGYN Beltran had also briefly seen at the clinic. Beltran explained that she no longer intended to take the drug, and that a prescription would not be necessary.

The physician’s assistant was concerned about the patient, and reported Beltran. A few days after her check-up appointment, a social worker showed up at her door. For Beltran, that was when the real nightmare began. The social worker said that she needed to restart Suboxine to prevent her from taking any other drugs, or be court-ordered to do so. Beltran explained that she did not want to restart Suboxine, and that she was not at risk for restarting her Percoset addiction. She admits that the social worker upset her deeply, and when she slammed the door, she said something about considering an abortion.

A few days after this incident, a sheriff showed up at Beltran’s door and placed her under arrest. She was brought to court, and the terrified young woman was introduced to a lawyer that had been assigned to her unborn fetus. She asked for a lawyer for herself, but wasn’t given one. She was then remanded to a 78-day stay at a drug addiction facility to treat a problem that, as later urine tests showed, she simply did not have. She reports that she was given an option between the treatment facility and jail.

Now, Beltran is fighting back. She is part of a federal suit that aims to declare the Wisconsin “cocaine mom” unconstitutional. Lynn M. Paltrow, Executive Director of National Advocates for Pregnant Women told the New York times about the ramifications of these types of laws, saying “this is what happens when laws give officials the authority to treat fertilized eggs, embryos and fetuses as if they are already completely separate from the pregnant woman.”

The future of this case in court may have interesting effects on the large and vast fetal personhood argument that has been occurring for the past few years all across the United States. If the Federal Court decides that a woman can be held against her will in the name of protecting a fetus; namely that the life of a fetus supersedes the rights of a mother—that decision could have an important effect on the forward movement of fetal personhood cases nationwide. On the flip-side, if they rule that the law is unconstitutional, that precedent could be used as an argument to block fetal personhood efforts in some states.

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Anneliese Mahoney (@AMahoney8672) is Lead Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

Featured image courtesy of [alenka_getman via Flickr]

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

The post “Cocaine Mom” Law’s Horrifying Effects appeared first on Law Street.